Cardioprotective effects of the MR contrast agent MnDPDP and its metabolite MnPLED upon reperfusion of the ischemic porcine myocardium

Purpose: To evaluate whether manganese dipyridoxyl diphosphate (MnDPDP) or its metabolite manganese dipyridoxyl ethyldiamine (MnPLED) reduces post-ischemic myocardial injury.

Material and Methods: Left anterior descending artery (LAD) in anesthetized pigs was occluded (30 min) followed by reperfusion (120 min) during hemodynamic monitoring and infarct assessment. Three μmol/kg MnDPDP, 1 μmol/kg MnPLED (or a mixture of both) or saline was injected i.v. 10 min before reperfusion followed by infusion of either 3 μmol/kg/h MnDPDP, 1 μmol/kg/h MnPLED (or a mixture of both) or saline. The plasma concentrations of MnDPDP, MnPLED and other metabolites (e.g., ZnDPDP and ZnPLED) were analyzed.

Results: Femoral blood flow was reduced by 60% during early reperfusion in controls, whereas only 23 and 31% reductions were seen in animals treated with MnDPDP and MnPLED. During that time, +LV/dP and -LV/dP (maximum rate of left ventricular isovolumic contraction and relaxation, respectively), systolic pressure and diastolic pressure fell significantly less in animals treated with MnDPDP or MnPLED. Three out of 5 control animals experienced ventricular fibrillation (VF) during reperfusion, whereas VF was not seen in any of the pigs treated with MnPLED or/and MnDPDP. The infarct sizes in saline- and MnPLED-treated animals were 39±6 and 16±5%, respectively, of the occluded areas. MnDPDP did not reduce the infarct size. A mixture of MnDPDP and MnPLED significantly reduced infarct size (10±4%). When reperfusion started and throughout reperfusion, almost all injected MnDPDP was present as Zn-metabolites.

Conclusion: MnPLED seems to reduce reperfusion-induced cardiac dysfunction and infarct size in pigs. MnDPDP does not reduce infarct size in the pig, probably because of the rapid exchange of Mn2+ for Zn2+ taking place in the pig.

Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy

Aims

Cardiac resynchronization therapy (CRT) in heart failure is limited by many non-responders. This study explores whether degree of wasted left ventricular (LV) work identifies CRT responders.

Methods and results

Twenty-one patients who received CRT according to guidelines were studied before and after 8 ± 3 months. By definition, segments that shorten in systole perform positive work, whereas segments that lengthen do negative work. Work was calculated from non-invasive LV pressure and strain by speckle tracking echocardiography. For each myocardial segment and for the entire LV, wasted work was calculated as negative work in percentage of positive work. LV wall motion score index (WMSI) was assessed by echocardiography. Response to CRT was defined as ≥15% reduction in end-systolic volume (ESV). Responder rate to CRT was 71%. In responders, wasted work for septum was 117 ± 102%, indicating more negative than positive work, and decreased to 14 ± 12% with CRT (P < 0.01). In the LV free wall, wasted work was 19 ± 16% and showed no significant change. Global LV wasted work decreased from 39 ± 21 to 17 ± 7% with CRT (P < 0.01). In non-responders, there were no significant changes. In multiple linear regression analysis, septal wasted work and WMSI were the only significant predictors of ESV reduction (β = 0.14, P = 0.01; β = 1.25, P = 0.03). Septal wasted work together with WMSI showed an area under the curve of 0.86 (95% confidence interval 0.71–1.0) for CRT response prediction.

Conclusion

Wasted work in the septum together with WMSI was a strong predictor of response to CRT. This novel principle should be studied in future larger studies.

A pilot study quantifying the shape of tidal breathing waveforms using centroids in health and COPD

During resting tidal breathing the shape of the expiratory airflow waveform differs with age and respiratory disease. While most studies quantifying these changes report time or volume specific metrics, few have concentrated on waveform shape or area parameters. The aim of this study was to derive and compare the centroid co-ordinates (the geometric centre) of inspiratory and expiratory flow-time and flow-volume waveforms collected from participants with or without COPD. The study does not aim to test the diagnostic potential of these metrics as an age matched control group would be required. Twenty-four participants with COPD and thirteen healthy participants who underwent spirometry had their resting tidal breathing recorded. The flow-time data was analysed using a Monte Carlo simulation to derive the inspiratory and expiratory flow-time and flow-volume centroid for each breath. A comparison of airflow waveforms show that in COPD, the breathing rate is faster (17 ± 4 vs 14 ± 3 min(-1)) and the time to reach peak expiratory flow shorter (0.6 ± 0.2 and 1.0 ± 0.4 s). The expiratory flow-time and flow-volume centroid is left-shifted with the increasing asymmetry of the expired airflow pattern induced by airway obstruction. This study shows that the degree of skew in expiratory airflow waveforms can be quantified using centroids.

Estimation of tidal ventilation in preterm and term newborn infants using electromagnetic inductance plethysmography

Tidal volume (VT) measurements in newborn infants remain largely a research tool. Tidal ventilation and breathing pattern were measured using a new device, FloRight, which uses electromagnetic inductive plethysmography,and compared simultaneously with pneumotachography in 43 infants either receiving no respiratory support or continuous positive airway pressure (CPAP).Twenty-three infants were receiving CPAP (gestational age 28 ± 2 weeks, mean ± SD) and 20 were breathing spontaneously (gestational age 34 ± 4 weeks). The two methods were in reasonable agreement, with VT (r2 = 0.69) ranging from 5 to 23 ml (4–11 ml kg−1) with a mean difference of 0.4 ml and limit of agreement of −4.7 to + 5.5 ml. For respiratory rate, minute ventilation,peak flow and breathing pattern indices, the mean difference between the two methods ranged between 0.7% and 5.8%. The facemask increased the respiratory rate (P < 0.001) in both groups with the change in VT being more pronounced in the infants receiving no respiratory support. Thus, FloRight provides an easy to use technique to measure term and preterm infants in the clinical environment without altering the infant's breathing pattern.

Prevalence of raised Yersinia enterocolitica antibody titre in unselected, adult populations in Denmark during 12 years

Yersinia enterocolitica biotype 4, serotype 0:3 is by far the most common human pathogenic Yersinia enterocolitica subtype in Scandinavia. It is extraordinarily immunologically specific, and an elevated antibody titre greater than or equal 80-160 is known to indicate acute infection. This titre was measured in five population surveys conducted in 1967-78, including 3278 examined adult men and women. The prevalence of titre elevation greater than or equal to was 1.0% in 1967. In 1978 it was significantly higher, 7.7%, and also the individual course of the titre in a ten-year longitudinal survey showed a significant increase in this prevalence, indicating an increasing incidence of infection. Significant sex and age differences were seen, women and younger subjects being more frequently affected than men and older subjects. The prevalence of elevated titre showed a seasonal variation with a maximum in the spring and autumn.

Cardiac fibrinolytic capacity is markedly increased after brief periods of local myocardial ischemia, but declines following successive periods in anesthetized pigs

BACKGROUND

Fibrinolysis in blood is mainly reflected by the activities of tissue plasminogen activator (tPA) and of plasminogen activator inhibitor-1 (PAI-1). The effect of myocardial ischemia on their activities in the coronary circulation is, however, not established.

OBJECTIVES

With an improved experimental model, we therefore examined the effect of a brief period of myocardial ischemia on their activities. Furthermore, the consequences of repeated periods of ischemia, mimicking the situations in patients with unstable angina, were investigated.

METHODS

In six anesthetized pigs, we occluded the distal left anterior descending coronary artery (LAD) four times for 10 min with 40 min intervals and determined the activities of tPA and PAI-1 in arterial and coronary venous blood. By simultaneously recording LAD flow, we could estimate cardiac release of these factors at baseline conditions and during reperfusion.

RESULTS

Neither net cardiac release of PAI-1 nor alterations in plasma PAI-1 levels were demonstrated during the experiment. However, a significant net release of tPA activity of 10.4 +/- 3.2 IU mL(-1) (P < 0.005) was recorded during baseline conditions. During reperfusion following the first period of ischemia, the cardiac release of tPA activity increased to a peak of 103 +/- 30-fold baseline release, but declined progressively after repeated periods of ischemia. After the fourth period, tPA release did not exceed an estimated baseline accumulation during ischemia and early reperfusion.

CONCLUSIONS

In this porcine model, a substantial local increase in fibrinolytic capacity was observed after brief periods of ischemia, but declined subsequently by repeated periods of ischemia.

Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs

The need for rescue breathing during the initial management of sudden cardiac arrest is currently being debated and reevaluated. The present study was designed to compare cerebral oxygen delivery during basic life support (BLS) by chest compressions only with chest compressions plus ventilation in pigs with an obstructed airway mimicked by a valve hindering passive inhalation. Resuscitability was then studied during the subsequent advanced life support (ALS) period. After 3 min of untreated ventricular fibrillation (VF) BLS was started. The animals were randomised into two groups. One group received chest compressions only. The other group received ventilations and chest compressions with a ratio of 2:30. A gas mixture of 17% oxygen and 4% carbon dioxide was used for ventilation during BLS. After 10 min of BLS, ALS was provided. All six pigs ventilated during BLS attained a return of spontaneous circulation (ROSC) within the first 2 min of advanced cardiopulmonary resuscitation (CPR) compared with only one of six compressions-only pigs. While all except one compressions-only animal achieved ROSC before the experiment was terminated, the median time to ROSC was shorter in the ventilated group. With a ventilation:compression ratio of 2:30 the arterial oxygen content stayed at 2/3 of normal, but with compressions-only, the arterial blood was virtually desaturated with no arterio-venous oxygen difference within 1.5-2 min. Haemodynamic data did not differ between the groups. In this model of very ideal BLS, ventilation improved arterial oxygenation and the median time to ROSC was shorter. We believe that in cardiac arrest with an obstructed airway, pulmonary ventilation should still be strongly recommended.

Increased spillover of norepinephrine to the portal vein during CO-pneumoperitoneum in pigs

BACKGROUND

Elevated intra abdominal pressure (IAP) during CO2-insufflation has been associated with increased catecholamine concentrations in plasma. We have previously indicated that this may be due to a regional increased spillover from the abdominal region. In this experimental study we investigated catecholamine spillover from the drainage area of the portal vein during CO2-pneumoperitoneum.

METHODS

Eight pigs under general anesthesia were investigated before and after CO2-pneumoperitoneum with an IAP of 15 mmHg. Regional spillover of catecholamines was determined by measuring plasma catecholamine concentrations and flow simultaneously. Plasma concentrations of catecholamines were measured from the portal and femoral veins, the pulmonary and carotid arteries. Flow data were collected with laser-Doppler transit time flow probes around the portal and femoral veins. Cardiac output was measured by the thermo-dilution technique. Estimated spillover was calculated by the veno-arterial difference multiplied by flow.

RESULTS

We found a significant increase in estimated spillover of norepinephrine from the drainage area of the portal vein from 10 (-1.2, 78) ng x min(-1) to 27 (1.8, 475) ng x min(-1)[median (range)] (P = 0.05), but no change in estimated spillover of norepinephrine from the drainage area of the femoral vein. Plasma concentrations of norepinephrine increased in central venous and arterial blood. There was no significant change in epinephrine concentrations in arterial blood.

CONCLUSION

Estimated norepinephrine spillover from the drainage area of the portal vein increased during CO2-pneumoperitoneum in pigs. This may indicate that the increased norepinephrine concentrations found in arterial plasma reflects a local activation of sympathetic nerves in the region of the portal drainage area.

Quality of CPR with three different ventilation:compression ratios

Current adult basic cardiopulmonary resuscitation (CPR) guidelines recommend a 2:15 ventilation:compression ratio, while the optimal ratio is unknown. This study was designed to compare arterial and mixed venous blood gas changes and cerebral circulation and oxygen delivery with ventilation:compression ratios of 2:15, 2:50 and 5:50 in a model of basic CPR. Ventricular fibrillation (VF) was induced in 12 anaesthetised pigs, and satisfactory recordings were obtained from 9 of them. A non-intervention interval of 3 min was followed by CPR with pauses in compressions for ventilation with 17% oxygen and 4% carbon dioxide in a randomised, cross-over design with each method being used for 5 min. Pulmonary gas exchange was clearly superior with a ventilation:compression ratio of 2:15. While the arterial oxygen saturation stayed above 80% throughout CPR for 2:15, it dropped below 40% during part of the ventilation:compression cycle for both the other two ratios. On the other hand, the ratio 2:50 produced 30% more chest compressions per minute than either of the two other methods. This resulted in a mean carotid flow that was significantly higher with the ratio of 2:50 than with 5:50 while 2:15 was not significantly different from either. The mean cerebrocortical microcirculation was approximately 37% of pre-VF levels during compression cycles alone with no significant differences between the methods. The oxygen delivery to the brain was higher for the ratio of 2:15 than for either 5:50 or 2:50. In parallel the central venous oxygenation, which gives some indication of tissue oxygenation, was higher for the ratio of 2:15 than for both 5:50 and 2:50. As the compressions were done with a mechanical device with only 2-3 s pauses per ventilation, the data cannot be extrapolated to laypersons who have great variations in quality of CPR. However, it might seem reasonable to suggest that basic CPR by professionals should continue with ratio of 2:15 at present if it can be shown that similar brief pauses for ventilation can be achieved in clinical practice.

Circulatory responses to a meal in patients with a newly transplanted heart

It is well established that consumption of a meal releases a gradually developing and quite marked increase in blood flow to the gastrointestinal organs and a similar and simultaneous increase in cardiac output (CO). It is not known through which mechanism the pumping of the heart adjusts so accurately to the gastrointestinal flow increase. We have approached this problem by serving a standardized, mixed meal to five patients with recently transplanted and thus denervated hearts and to five sex- and age-matched controls. Pre- and postprandial levels of CO and blood flow in the superior mesenteric artery (SMA) were recorded with Doppler ultrasound technique. The patients with transplanted hearts had significantly higher preprandial levels of heart rate (HR) and CO than the controls. With a timing similar to that seen in the controls did all five patients develop considerable and synchronous postprandial increases in superior mesenteric arterial flow and in CO. Increases in superior mesenteric arterial flow were significantly greater than the controls. Also, COs, high even before meals were given, increased further and to the same relative extent as in the control persons. The marked postprandial increase in CO, probably secondary to the increase in intestinal blood flow, could hardly come about through any sort of nervous reflex to the recently transplanted and denervated hearts. It appears more likely that a humoral connection of some sort exists between the two circulatory events.

Muscle contractile properties during intermittent nontetanic stimulation in rat skeletal muscle

To examine changes in contractile properties and mechanisms of fatigue during submaximal nontetanic skeletal muscle activity, in situ perfused soleus (60-min protocol) and extensor digitorum longus (EDL; 10-min protocol) muscles of the rat were electrically stimulated intermittently at low frequency. The partly fused trains of contractions showed a two-phase change in appearance. During the first phase, relaxation slowed, one-half relaxation time increased, and maximal relaxation first derivative of force (dF/dt) decreased. Developed force during the trains was reduced and was closely related to the rate of relaxation in this first phase. During the second phase, relaxation became faster again, one-half relaxation time decreased, and force returned to resting levels between contractions in a train. In contrast, developed force remained reduced, so that peak force of the contractions was 51% (soleus) and 30% (EDL) of control. In the soleus muscle, the changes in contractile properties were not related to ATP, creatine phosphate, or lactate content. The changes in contractile properties fit best with a mechanism of fatigue involving changes in Ca(2+) handling by the sarcoplasmic reticulum.

Reducing CPR artefacts in ventricular fibrillation in vitro

CPR creates artefacts on the ECG, and a pause in CPR is therefore mandatory during rhythm analysis. This hands-off interval is harmful to the already marginally circulated tissues during CPR, and if the artefacts could be removed by filtering, the rhythm could be analyzed during ongoing CPR. Fixed coefficient filters used in animals cannot solve this problem in humans, due to overlapping frequency spectra for artefacts and VF signals. In the present study, we established a method for mixing CPR-artefacts (noise) from a pig with human VF (signal) at various signal-to-noise ratios (SNR) from -10 dB to +10 dB. We then developed a new methodology for removing CPR artefacts by applying a digital adaptive filter, and compared the results with this filter to that of a fixed coefficient filter. The results with the adaptive filter clearly outperformed the fixed coefficient filter for all SNR levels. At an original SNR of 0 dB, the restored SNRs were 9.0+/-0.7 dB versus 0.9+/-0.7 dB respectively (P<0.0001).

Mental disorders in medical inpatients and the association to severity of illness, self-rated physical disability, and health perception

In a study of 294 consecutive medical inpatients, the authors assessed a subsample of 157 patients for psychiatric diagnoses using an extensive semistructured interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients rated their health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A life-threatening condition increased odds for having a psychiatric diagnosis by 3.1 times (95% Confidence Interval (CI): 1.03-9.1), while a chronic medical disease had no such impact (OR=1.1; 95% CI: 0.5-2.3). In women, mental disorders were strongly associated with self-rated disability (OR=6.7; 95% CI: 1.6-27.8) and self-rated health (OR=9.4; 95% CI: 2.7-32.4). This association was absent in men (OR(disability)=0.7; 95% CI: 0.2-2.7; OR(health)=1.6; 95% CI: 0.6-4.7). Analyses included adjustment for age and gender.

Electrophysiological evidence of reinnervation of the transplanted human heart

Beat-by-beat heart rate (HR) changes during exercise were studied in two young and fit heart-transplanted humans at different time intervals following transplantation. Upon the start of the exercise, a slow gradual increase in HR was seen during the early experiments after the transplantation, whereas an immediate rapid increase in HR was observed during the later experiments. From standard ECGs obtained 32 months after transplantation, two P waves at somewhat different rates could be identified in both subjects, probably arising from donor and recipient sinoatrial nodes, respectively. The two P wave rate changes during and following exercise were very similar. We conclude that these changes in the HR pattern and ECG must be due to reinnervation of the donor hearts, most likely by parasympathetic cardiac fibers.

Development of oxygen sensitivity in infants of smoking and non-smoking mothers

AIMS

To assess the effect of prenatal cigarette smoke exposure on the postnatal resetting of oxygen sensitivity in term infants.

METHODS

15 healthy term infants of smoking mothers (median 10 cigarettes/day) and 16 controls were studied during quiet sleep 1, 3, and 10 days and 10 weeks postnatally. Strain-gauge respiratory trace was continuously recorded. Repeated 15-s challenges with 100% O2 and 15% O2 were presented in randomised order through a face mask. A median of six hyperoxic and six hypoxic challenges per recording were obtained. Breath-by-breath ventilation in a time-window from 20 s before onset of stimulus to 60 s after was extracted. For each infant at each age, the normalised coherently averaged response to hyperoxia and hypoxia was calculated. Mean ventilation at end of the 15-s stimulus was analysed with ANOVA, as were parameters describing a function fitted to each averaged response.

RESULTS

During air breathing, smoke-exposed infants had higher respiratory rates and lower tidal volumes than controls. Nicotine concentration in infant hair, measured by gas chromatography, was positively correlated with maternal level of smoking. A long-term development in oxygen sensitivity was demonstrated in both groups. However, neither the time-course nor the magnitude of O2 responses was affected by maternal smoking. Overall, hyperoxia reduced ventilation by 6.3% at day 1, 13.2% at day 3, 29.6% at day 10, and 40.0% at week 10. Transient hypoxia increased ventilation by 3.5%, 3.2%, 6.4%, and 8.8%, respectively, at the four ages studied.

Involvement of the human splanchnic circulation in pressor response induced by handgrip contraction

We have analysed the adjustment of blood flow and vascular conductance in the abundantly supplied splanchnic circulation to a generally released pressor reaction. Pressor responses were induced by 2-min periods of standardized, sustained handgrip in seven healthy students. The effects of handgrip tests were followed both in the fasting state and after the consumption of a substantial, mixed meal. In the first of the two sessions, changes in superior mesenteric artery blood flow were recorded and concomitant changes in local vascular conductance derived. In the other session, pressor released cardiac output changes were recorded and changes in total peripheral vascular conductance derived. Both types of flow changes were recorded using ultrasound Doppler technique. Typically, blood flow in the superior mesenteric artery increased two- to threefold after a meal. Handgrip contractions induced an initial rapid increase in heart rate, cardiac output and total peripheral conductance, followed by a gradual decline in total peripheral conductance and stroke volume and a gradual increase in heart rate and mean arterial pressure for the rest of the period. At the end of 2-min pressor periods, total peripheral conductance was only about 10% below the pre-handgrip level, whereas vascular conductance locally in the area of the superior mesenteric artery decreased by some 30%. Thus, it appears that the splanchnic vascular bed contributes markedly to the compound pressor response. Handgrips caused significantly less reduction in local vascular conductance in the post-prandial than in the pre-prandial state, indicating that blood flow to the digesting gastrointestinal tract retains a relatively high priority also in a pressor situation.

A method of assessing ventilatory responses to chemoreceptor stimulation in infants

Various methods of assessing infant chemoreceptor responses have been reported in the literature. However, equipment dead space, trigeminal stimulation and inherent respiratory variability may have affected the results. A method is presented which attempts to reduce the effect of these factors and thereby isolate the chemoreceptor response. Inspiratory gas was delivered into a lightweight face mask with a pliable rim, minimal dead space and a connected pneumotachograph. Ventilatory data were computed breath by breath. Computer-controlled electromagnetic valves allowed instantaneous switching between air and different gas mixtures, repeated in a randomized sequence. In 18 healthy term neonates, the mask increased ventilation by 12% (95% confidence interval 6-18%), measured by calibrated strain-gauge bands. The effect on respiratory frequency and tidal volume differed significantly between sleep states. Neonates were challenged with short-lasting hyperoxia, mild hypoxia, rebreathing and mild hypercapnia. Coherent averaging of several ventilatory responses from each sleep state reduced the variability while maintaining a high time-resolution.

Local constriction of arteriovenous anastomoses in the cooled finger

We have examined the influence of local cooling from 35 to 19 degrees C on spontaneous arterial blood velocity fluctuations in the acral skin of thermoneutral subjects. The skin temperature of one hand was gradually lowered in a water bath in two separate experimental runs. Simultaneous continuous blood velocity was measured from the third finger artery of both hands using ultrasound-Doppler. The large blood velocity fluctuations assumed to be caused by synchronous vasomotion of the arteriovenous anastomoses were invariably seen in the control finger artery throughout the two cooling periods, indicating that the subjects were in their thermoneutral zone. The velocity fluctuations on the cooled side remained nearly unchanged and closely correlated with those in the control finger artery during local cooling from 35 to approximately 21.5 degrees C. Below this temperature (range 23-20 degrees C) the velocity fluctuations ceased abruptly, and the velocity was nonfluctuating and continuously low. These results indicate a local thermal level below which there is abrupt, sustained closure of the arteriovenous anastomoses.

Effect of ultrasound contrast medium in color Doppler and power Doppler visualization of blood flow in canine kidneys

PURPOSE

To examine the effect of an ultrasound contrast medium (UCM) in the visualization of parenchymal blood flow by means of color Doppler and power Doppler sonography.

MATERIAL AND METHODS

Nonenhanced and UCM-enhanced Doppler images of canine kidneys were obtained in a transversal plane during various states of flow reduction in the anterior branch of the renal artery. The UCM consisted of air-filled shell-stabilized microballoons (half-life approximately 2 min). The images were evaluated blindly by 4 observers who rated the amount of flow signal in the cortex and medulla, and categorized the flow state (normal, reduced or no flow) in the anterior part of the kidney.

RESULTS

The UCM increased the area of Doppler signals in the cortex and outer medulla during normal or reduced blood flow. The border between nonperfused and normally perfused parenchyma was more distinct with the UCM. The categorization of the regional flow state was more correct with the UCM. Improvement with the UCM was greatest when the nonenhanced Doppler images had suboptimal intensity, but positive effects with the UCM were also seen in recordings with adequate precontrast intensity. Color blooming artifacts sometimes occurred on the side of the kidney facing away from the transducer.

CONCLUSION

The UCM improved the color Doppler and power Doppler visualization of the parenchymal blood flow in the canine kidney, and allowed a more correct categorization to be made of the regional blood flow state.

Short-term control of cardiovascular function: estimation of control parameters in healthy humans

In a previous study, we recorded short-term cardiovascular responses after a steep increase in arterial pressure in healthy humans [Am. J. Physiol. 266 (Heart Circ. Physiol. 35): H199-H211, 1994]. The aim of the present study was to develop a mathematical model of the baroreflex control of arterial pressure, to use this model with the previously recorded data to estimate unknown parameters in the reflex control loop, and then to analyze the overall open- and closed-loop performance of the system by model simulations with use of individual sets of optimal parameters. The mathematical model consists of a heart, a linear elastic arterial reservoir, and two parallel resistive vascular beds. The arterial baroreflex loop is modeled by two separate time domain processing objects, each with its own gain, time constant, and delay, to simulate the action of a sympathetic signal to the peripheral vascular bed and a parasympathetic signal to the heart. In repeated model simulations, the control parameters in the model were systematically adjusted by an automated algorithm that minimized the deviations between the time courses of the cardiovascular variables simulated by the model and the previously recorded responses in each individual. In all 10 subjects, the short-term cardiovascular responses were adequately simulated by using individual sets of parameters in the model. Open-loop transfer functions for arterial pressure control were obtained by using the individual sets of optimal model parameters in new simulation runs. Open-loop gain for arterial pressure control at nearly zero frequency (steady state) was between 0.9 and 4. Model simulations also indicated an underdampened response at 0.05-0.07 Hz in the closed-loop situation in four subjects, corresponding to peaks in the mean arterial pressor power spectra obtained from separate recordings of spontaneous variations in the resting situation.

Effect of local warming on hand and finger artery blood velocities

The effect of local heating on blood velocities in arteries supplying the skin of hand and fingers was studied in subjects kept in their thermoneutral zone. The temperature of one hand was steadily raised from 35 to 43 degrees C in 15 min, whereas the control hand was kept in the air or immersed in a water bath at 35 degrees C. Simultaneous blood velocity recordings from the two hands were made continuously using ultrasound Doppler. In the heated hand, a general rise in blood velocity level was seen. However, the spontaneous fluctuations in blood velocity assumed to be caused by synchronous vasomotor activity of the arteriovenous anastomoses (AVAs) remained unchanged and closely correlated with those in the control hand throughout the experiment. Thus the central nervous control of AVA vasomotion seems to be unaffected by local heating. The elevation of blood velocity in the heated hand is probably due to dilatation of other parts of the vascular bed, e.g., ordinary arterioles in the skin. Earlier investigators, using venous occlusion plethysmography, have reported vasoconstriction in the locally heated human finger. No sign of such heat-induced vasoconstriction was found in this study.

Spontaneous flow waves detected by laser Doppler in human skin

The contribution of spontaneous variations in sympathetic nervous activity and perfusion pressure to the laser Doppler flux signal in human skin was studied in nine healthy subjects. Simultaneous recordings were made of laser Doppler flux, mean blood pressure, and blood flow in the radial artery. In the skin of the palm and sole, there was a significant and strong correlation between fluctuations in flux and radial artery velocity, which indicated a high degree of neural control of microcirculatory blood flow. This correlation decreased progressively toward the trunk and face. In the skin of the nose and at scattered sites on the face, trunk, and extremities, there was correlation between flux and mean blood pressure that indicated a predominantly "passive" vascular bed. At other sites, multivariate regression analysis revealed contributions of both blood pressure and sympathetic activity. In skin on the ear and forehead, a characteristic pattern of regular oscillations in flux, uncorrelated with blood pressure and sympathetic activity, was demonstrated. The laser Doppler signal from different skin sites thus contains varying contributions from variations in perfusion pressure, sympathetic nervous activity, and local, myogenic arteriolar vasomotion.

A causal relationship between fluctuations in thermoregulatory skin perfusion and respiratory movements in man

The relationship between regular respiration with normal tidal volume and spontaneous fluctuations in blood flow through skin arteriovenous anastomoses (AVAs) was investigated. Laser Doppler measurements from skin areas known to contain arteriovenous anastomoses, ultrasound Doppler measurements from the radial artery and respiratory movements were recorded simultaneously in 7 supine human subjects in a thermoneutral environment. The phase relationship between respiration and the onset of sudden arteriovenous anastomoses vasoconstrictions was calculated in each subject. A few seconds before a vasoconstriction, there was a clear tendency towards synchrony in the respiration recordings, indicating that some respiration-phase-dependent event precedes the vasoconstrictions. Since arteriovenous anastomoses constrictions are accompanied by specific changes in heart rate and blood pressure, our findings link respiration to low-frequency heart rate and blood-pressure variability in humans.

Acute effects of indometacin on cerebral blood flow in man

Blood velocity changes in the internal carotid artery were estimated using Doppler ultrasound before, during and after injection of indometacin or placebo in 7 healthy adults. Upon injection of the active substance there was a rapid reduction in blood velocities in the internal carotid artery, increasing with increasing doses of indometacin. A fall in end-expiratory PCO2 was also observed, indicating a state of hyperventilation. The observed relative reduction in cerebral blood flow was much higher in all subjects than the expected reduction due to the accompanying drop in PCO2. Experiments in which arterial PCO2 was kept constant showed that indometacin also causes a reduction in blood velocity independent of changes in PCO2. We suggest that indometacin has both a direct effect on the cerebral microcirculation, and an additional effect mediated through induction of hyperventilation. The drug probably affects the respiratory center through an increase in intracerebral PCO2 due to reduced perfusion.

The status of local smoking regulations in North Carolina following a state preemption bill

OBJECTIVE

To determine the number and protectiveness of local smoking regulations adopted before the implementation of a preemptive statewide smoking control bill.

METHOD

Review of local smoking control regulations from all 100 counties and 85 municipalities with populations greater than 5000 in North Carolina.

MAIN OUTCOME MEASURES

Adoption of local smoking control regulations before and during the 3-month delay in enactment of the preemptive bill. Protectiveness of regulations was based on restrictions on smoking and requirements for separate ventilation systems at private work sites: none (smoking unrestricted); minimal (smoking restricted to designated areas); partial (smoking restricted to designated areas served by separate ventilation systems); and complete (smoking prohibited). Because some regulations would be phased in gradually over the next 5 years, we evaluated the requirements that will be in effect by January 1, 2000.

RESULTS

Between July 15 and October 15, 1993, the number of local smoking regulations in North Carolina increased from 16 to 105. By the year 2000, 59% of private employees still will not be guaranteed any protection from work site environmental tobacco smoke; 19% will have minimal protection, 22% will have partial protection, and none will have complete protection.

CONCLUSIONS

The 3-month delay in preemption created an unnatural time frame for communities to organize, debate, and adopt smoking restrictions. Despite the adoption of 89 new regulations, no private employees will be guaranteed complete protection from work site environmental tobacco smoke by the year 2000; new regulations can no longer be adopted. HB 957 has been a setback for public health in North Carolina.

Connection between skin arteriovenous shunt flow fluctuations and heart rate variability in infants

Large, spontaneous fluctuations in blood flow to acral skin, caused by synchronous opening and closing of arteriovenous anastomoses (AVAs), have been demonstrated in adults in a thermoneutral environment. Individual AVA constrictions were accompanied by a diphasic heart rate (HR) response, indicating the presence of an autonomic rhythm which affected both skin AVA activity and heart rate variability. In the present study, 24 neonates were examined on day 2 (range 1-3 days) and re-examined at 14 weeks (11-17 weeks). The presence of rhythmic, synchronous fluctuations in laser Doppler flux in the palm of the hand and sole of the foot in 20 of 24 neonates strongly indicated the presence of functional skin AVA at birth. Both neonates and 3-month-old infants showed a diphasic HR response in association with cutaneous AVA constrictions. The infant response differed from the adult response mainly by the longer duration of the secondary bradycardia. This may reflect different properties of the baroreceptor reflex in infants and adults.

Peripheral vasoconstriction shortly after onset of moderate exercise in humans

The immediate cardiovascular responses at the onset of supine dynamic leg exercise were studied by noninvasive methods in healthy humans. Total peripheral conductance (TPC), heart rate, and cardiac output increased very rapidly at the onset of exercise. Mean arterial pressure (MAP) showed a moderate anticipatory increase during a 10-s countdown to exercise and then decreased (but not below resting level) during the first 10 s of exercise. The TPC response was biphasic, and TPC started to fall from its peak value approximately 12 s after onset of exercise. This peripheral vasoconstriction increased MAP. After 25 s, the cardiovascular variables were stable for the rest of the 2-min exercise period. In the same subjects, cholinergic blockade was induced by atropine sulfate (0.035 mg/kg) and resting cardiac output, MAP, and TPC increased considerably. The exercise protocol was repeated after atropine, and the increase in heart rate at onset of exercise was slower and smaller. MAP decreased and remained depressed throughout the exercise period. A monophasic increase in TPC was seen. We suggest that, in the normal situation, the biphasic response in TPC reflects a baroreflex sympathetic vasoconstriction very shortly after onset of exercise and that this response is due to a rapid increase in set point for arterial pressure control at the onset of exercise. After cholinergic blockade, MAP was probably continuously well above the set point for arterial pressure control both before and during exercise and no reflex vasoconstriction was observed in this situation.

Thermoregulatory fluctuations in heart rate and blood pressure in humans: effect of cooling and parasympathetic blockade

The spontaneous fluctuations in acral skin blood flow, mean blood pressure (MAP), and heart rate (HR) were studied in 9 healthy supine volunteers in a thermoneutral and in a cool environment, and after parasympathetic blockade by atropine. In skin areas with a high density of arteriovenous anastomoses (AVAs), there were large, spontaneous fluctuations in blood flow in a thermoneutral environment. The fluctuations were nearly abolished in a cool environment, while they seemed unaffected by atropine administration. Power spectral analysis demonstrated a reduction in HR and MAP variability in the low- and mid-frequency (LF) (< 0.15 Hz) band after cooling, and a prominent reduction in HR variability in both the LF and the high-frequency (HF) (< 0.15 Hz) band after atropine administration. A sudden drop in skin vascular conductance was accompanied by diphasic HR changes and an increase in MAP. After atropine administration, the initial HR acceleration was delayed and reduced in magnitude. The secondary HR deceleration, which probably represents baroreceptor modulation, was abolished. Atropine administration caused a delayed, but augmented increase in MAP, which was probably related to the loss of baroreceptor control of HR. The presence of an autonomic rhythm, consisting of sympathetic vasoconstrictor impulses to skin AVAs, connected with reciprocal sympathetic and vagal impulses to the heart, is indicated. The HR changes were mainly determined by vagal activity. The rhythmic changes in skin blood flow, HR and MAP were suppressed in a cool environment.

Results of the Dutch community project "Healthy Bergeyk"

BACKGROUND

This article reports on the results of a community health project that was implemented in the Dutch municipality of Bergeyk. The major goal was to reduce four cancer-related risk behaviors: smoking, high fat consumption, excessive alcohol use, and exposure to artificial sunlight. A control community received no new intervention. Intervention methods included mass media messages, self-help materials, small group activities, lectures, and structural activities. Community organization principles such as a social network approach, community participation, and intersectoral cooperation were applied in the project.

METHODS

Data were collected from both communities among cohort research samples on three occasions using telephone interviews.

RESULTS

The results indicate a significant reduction in fat intake in the experimental community. No other significant behavioral effects were found. Further analysis among respondents in the experimental condition showed that those personally exposed to the project as indicated by familiarity with and discussion about the project, had a greater decrease in fat consumption between baseline survey and second post-test than those who were not. Also, the percentage of smokers who quit between baseline survey and second post-test was greater among those who knew about the project than among those who did not. Finally, discriminant analysis was used to further examine the determinants of project exposure. Community involvement, marital status, education, and sex were related to project exposure.

CONCLUSIONS

It is concluded that with the time limitations of the project in mind, the findings are encouraging.

Priority of blood flow to splanchnic organs in humans during pre- and post-meal exercise

Cardiac output and superior mesenteric arterial flow in five healthy young men were followed using Doppler ultrasound techniques at rest and during 4 min bouts of bicycle exercise in both a pre- and a post-meal situation. The meal given was mixed and heavy, with an energy content (related to body size) of about 1400-1600 kcal (5.9-6.9 MJ). Two levels of exercise, 50-65 W and 150-200 W (about 75% of VO2max), were tested, with the subjects cycling in a reclining position. Superior mesenteric arterial flow increased threefold, to about 1.1 l min-1, after the meal. During exercise in the fasting situation there were only modest changes in splanchnic vascular conductance, and moderate increases in superior mesenteric arterial flow were actually recorded. Exercise in the post-prandial state caused appreciable reductions in splanchnic vascular conductance, and a 38% reduction was observed during the most heavy exercise. However, not even such a decrease in conductance resulted in any definite reduction in superior mesenteric arterial blood flow, which was maintained at the pre-exercise level. Cardiac output increased by about 1.3 l min-1 after the meal. The exercise-induced increases in cardiac output were of the same order in the fasting and in the post-prandial state. Variance analyses showed the high cardiac output levels reached during post-prandial exercise to be no different from levels that would be reached by pure summation of the changes caused by eating alone and by exercise alone. It is concluded that blood flow to the splanchnic organs in reclining man retains its high pre- and post-prandial priority during short exercise bouts of up to 75% of VO2max.

Short-term cardiovascular responses to a step decrease in peripheral conductance in humans

A step decrease in total peripheral conductance (TPC) was introduced in 10 healthy volunteers by rapid inflation to suprasystolic pressure of bilateral thigh cuffs. This provoked a sudden statistically significant increase in mean arterial blood pressure (MAP) of 5 mmHg during supine rest and of 8 mmHg during moderate supine exercise by the quadriceps muscles. Central venous pressure was not changed by cuff inflation. The increase in MAP was blunted by a rapid but transient decrease in both heart rate (HR) and cardiac stroke volume. At rest, a gradual increase in TPC, starting after 4 s, nearly fully restored MAP to its original value at 10 s. During exercise, MAP was halfway corrected at 10 s but then started to increase again, probably as a result of an ischaemic muscle pressor response. After cholinergic blockade by atropine, the immediate HR response was eliminated, but HR decreased gradually after a delay of 3 s. The time development of the slow increase in TPC was not changed by atropine. In conclusion, the regulatory correction of a sudden increase in arterial pressure in supine unanesthetized healthy humans is achieved through an immediate transient parasympathetic bradycardia during the first few seconds and a more gradual sympathetic peripheral vasodilation after 4 s. After cholinergic blockade, a slow presumably sympathetic HR response was observed.

Respiration-synchronous fluctuations in stroke volume, heart rate and arterial pressure in humans

1. Simultaneous recordings of beat-to-beat left cardiac stroke volume (SV, pulsed ultrasound Doppler), mean arterial pressure (MAP) and heart rate (HR) were obtained in ten healthy young adults during spontaneous respiration at supine rest, before and after cholinergic blockade by atropine (0.035 mg kg-1). 2. Respiration-synchronous fluctuations in SV, HR, cardiac output (CO) and MAP were quantified by spectral analysis of the recordings of each of these variables. 3. Before atropine administration, respiration-synchronous fluctuations in HR and SV were prominent. The changes in HR and SV were inversely related and variation in SV was the main source of respiratory variability in CO. Respiration-synchronous fluctuations in MAP were mainly caused by variations in CO. 4. After cholinergic blockade, respiratory HR variations were eliminated, whereas the respiratory fluctuations in SV persisted. The fluctuations in CO and MAP increased. In this situation, mechanically induced variations in SV were not counteracted by inverse HR fluctuations and the influence on CO thus increased. 5. The main source of respiratory fluctuations in MAP in supine humans is thus variation in SV, while inverse, vagally mediated HR variations tend to reduce the fluctuations in CO and MAP.

The determinants of four cancer-related risk behaviours

This paper reports research into the determinants of four cancer-related risk behaviours: smoking, excessive alcohol consumption, high fat consumption and exposure to artificial sunlight. The results indicate that the four types of risk behaviour are determined by several factors: the perceived behaviour of the social environment, individual's attitudes towards the risk behaviour and self-efficacy perceptions on changing the risk behaviour. High fat consumption differs from the other risk behaviours in that people tend not to be aware of their high fat consumption. No significant relationships were found among the risk behaviours apart from small correlations between smoking and heavy alcohol consumption, and between high fat consumption and heavy alcohol consumption. The implications of these results for the development of behaviour change programs are discussed.